Covid19 and Women

The Coronavirus disease 2019 (COVID-19) pandemic has exposed glaring social, economic, political, and health inequalities, and has further widened the gap between the most privileged and most vulnerable communities across the globe. Women, people from ethnic minority backgrounds, and all gender-diverse individuals are subject to unique healthcare disparities that this pandemic has exacerbated (1).

Healthcare systems across the world have been overwhelmed trying to handle cases of COVID-19, as well as delivering and maintaining adequate standards of care for all non-COVID-19-related health demands. This has resulted in vast collateral damage to conditions and health problems that affect women (2). Pandemics make it difficult for women and girls to access and receive adequate medical care. Women and girls have unique health needs and are less likely to have access to quality health services, essential medicines and vaccines, and maternal and reproductive care, particularly in rural and marginalised communities (3). This is further compounded by multiple intersecting inequalities, such as ethnicity, socioeconomic status, disability, age, race, geographic location, and sexual orientation, which all influence access to critical health services and COVID-19 information (3). Many countries have failed to keep women’s health services fully functioning, with some even becoming completely neglected, such as sexual and reproductive health facilities (2). In fact, the United Nations (UN) Population Fund estimated that due to a 3.6-month delay to access family planning facilities, around 7 million unintended pregnancies across 115 low- and middle-income countries were recorded (2).

It is vital to understand and recognise that even without a global health crisis, the health of women and girls is subject to neglect and discrimination (2), and exponentially more so amidst a global pandemic.

Women are frontline workers and have caregiving responsibilities

Although there does not seem to be a sex or gender bias in the distribution of COVID-19 cases globally, men are more likely to progress to severe disease and death following infection (4). Despite this, discussions around the impact of COVID-19 on health must include the unique circumstances that make women more vulnerable (1) and disproportionately more affected by the pandemic. The gender-based burden of taking on unpaid and carer responsibilities often falls on women (4). In many parts of the world, this responsibility is often encouraged by traditional patriarchal family structures (5). The performance and demand of these health and social care roles have intensified over the lockdown period. Women currently occupy an overwhelming number of frontline healthcare roles and “essential” roles, such as nursing, midwifery, community health workers, teaching, cleaning, domestic services, and other consumer-facing jobs. In fact, approximately 70% of the global health workforce is made up of women (3), increasing their risk of exposure to the virus, and at a much higher viral load than men (6). The long-term health consequences of this are unknown, particularly as women are more likely to live with long COVID-19 compared to males.

However, it is also important to note that it is incorrect to assume women’s experiences of COVID-19 and the impact the pandemic has had on their health and lives are homogeneous (4). The challenges faced by women belonging to a Black, Asian, and Minority Ethnic (BAME) background, who are often employed as essential workers, is drastically different (4). In the United States (US), Black, Latina, low-income, immigrant women are at greatest risk of being uninsured and subsequently cannot access healthcare should they become sick from their caregiving roles (1). These women are more vulnerable to COVID-19 infection, and it prevents them from adhering to social distancing measures, accessing testing and treatment, and receiving economic relief from government programmes (1).

The disproportionate economic impacts of the pandemic on women further exacerbate their risk of prolonged contact with COVID-19 patients (1). With higher rates of redundancy and unemployment due to the pandemic, many women are forced to work part-time in healthcare facilities, thereby increasing their risk of exposure and transmission to others (1). Additionally, although personal protective equipment (PPE) is often marketed as “unisex”, they are manufactured according to traditional male proportions, resulting in women wearing ill-fitting PPE, which severely compromise their safety and protection from the virus (1).

Furthermore, living in quarantine has directly impacted women’s freedom amidst their work and caregiving responsibilities, and their ability to exercise and adhere to medical advice (4). As a result of this heavy burden of work, women are more likely to neglect their health concerns and delay visiting a GP. Women may be staying away from accessing medical care because of strict quarantine measures, but also because they are concerned about contracting the virus (7). This could be especially true for women who are in poor health and consider themselves to be at greater risk of COVID-19 exposure. However, it is important to note that skipping or delaying preventive health services against the backdrop of the pandemic could result in these women experiencing more severe health conditions after the global health crisis has ended. Furthermore, although the implementation of telemedicine has allowed women who have been identified by the government as ‘high-risk’ to continue approaching healthcare professionals, this availability and access is not equal for women of all socioeconomic or minority ethnic backgrounds.

The impact of COVID-19 on the mental health of women

Considering that the public health service only functions when women play multiple and unpaid roles, governments and hospital boards must recognise the contribution women have made and continue to make in battling COVID-19 (6). Aside from the health concerns exacerbated by lockdowns, the increased workload, isolation, and discrimination were also common in caregivers and could result in physical exhaustion, fear, emotional disturbance, and sleep disorders (6). In addition, few services were available to screen physicians and nurses in contact with infected patients for anxiety, depression and suicidality and provide counselling (6). The lack of adequate domestic and emotional support can have consequences on women’s mental health, especially as the risk of stress, anxiety, depression, and post-traumatic stress disorders is also much higher in females compared to males (6,5,8).

During lockdown, there was also an increase in domestic violence cases against women. Victims of sexual violence, emotional abuse, and stalking are at increased risk of multiple mental disorders, as well as somatic diseases (cardiovascular disease, chronic pain, sleep disturbances, gastrointestinal problems, sexually transmitted infections, traumatic brain injury) (6). As one can imagine, victims are unable to raise these healthcare concerns with a professional, which are further exacerbated by the effects of the pandemic.

Vaccine hesitancy amongst women

Pregnant women were classed as a vulnerable group early in the pandemic and there has been very little research into whether vaccines are safe for them. Millions of pregnant or breastfeeding women have been neglected from the programme indefinitely. If a vaccine has not been tested on pregnant women, it is unsurprising that this demographic may be hesitant about vaccination (9). Three-quarters of trials for any COVID-19 treatments or vaccines have explicitly excluded pregnant women, even though pregnant women who contract the virus are more likely to end up in intensive care (10). Therefore, the inclusion of women in clinical trials for COVID-19 treatment is urgently mandated; the documentation of the clinical course among women, with and without treatment, will allow us to fill the large evidence gap (10). Considering the scale of this global pandemic, it is a public health obligation to include pregnant women in vaccination trials and address the institutional, socioeconomic, and cultural barriers to their participation and hesitancy (10).

The reason for vaccine hesitancy in this demographic is the lack of knowledge about women’s bodies, from healthcare professionals, academic researchers, health policymakers, and women themselves. This is attributed to the historical exclusion of pregnant women in clinical trials following the thalidomide scandal of the 1960s. Racial and ethnic minorities are also vastly underrepresented in clinical research for historical and institutional reasons (1). Consequently, understanding women’s responses to medications have been hindered due to inadequate enrolment of women in scientific studies and the assumption that results of testing on male bodies would translate equally to women. Furthermore, most data on drug efficacy in pregnant women are gathered retrospectively from inadvertent exposure, which imposes greater risk than that incurred during regulated clinical trials (1).

Another plausible reason for vaccine hesitancy amongst women is that the healthcare system can often be hostile to women and their health needs; women are less likely to be believed when they approach medical professionals for their pain and chronic conditions and are often treated for psychological problems instead of physical symptoms. Therefore, women often have lower levels of trust in the medical establishment due to having their health issues repeatedly dismissed and neglected. It is likely that as medical science does not necessarily cater to women directly, and this attitude towards health services is something that women have internalised and may possibly contribute to vaccine hesitancy in this population.

To overcome this hesitancy, it is crucial that the complex reasons surrounding hesitancy are understood and that women’s concerns are heard and addressed clearly.

Public and health policy perspective

The COVID-19 pandemic has illuminated several “blind spots” in public and health policy (4), specifically the notion that the health of women and girls is not at the forefront of many healthcare systems that have continuously served white heterosexual males above all other demographic groups. However, this realisation (although arguably too late) is important so that going forward, we can find opportunities to conduct assessments on the impact of global health crises, as well as everyday ailments and diseases, across different communities. Overlooking the concerns of marginalised groups and disregarding their adequate representation at the conceptualisation stage of any health policy will inevitably entrench implicit biases (4), which will further widen the existing gender health gap that we must make a priority to close.

Although the COVID-19 pandemic has rampaged on for almost 2 years, it is far from over. It is still crucial that we ensure women of all socioeconomic and ethnic backgrounds can access telehealth, mental and sexual health services, as well as the provision of safe in-person care, for the remainder of the pandemic and beyond.

How can we learn from the COVID-19 pandemic and move forward to close the gender health gap? (2,3,1)

  • Policymakers and stakeholders must include women and girls at the centre of healthcare policies and listen to their needs, challenges, and solutions
  • Women’s health services must be recognised and normalised as ‘essential’ during outbreaks and crises
  • Integrate new teaching methods at schools and colleges to address girls and young women’s unique needs for safety, health, and wellbeing
  • Ensure that women and girls have access to COVID-19 public health messages, which must be targeted to different contexts and health concerns of women and girls. With limited access to education and therefore low levels of literacy in some communities worldwide, messaging must be culturally appropriate and understandable by all
  • Special attention needs to be given to the health, psychosocial needs, and work environment of frontline female health workers. PPE must be the appropriate size for women and the provision of hygiene and sanitation items must be considered essential
  • Concrete measures need to be implemented to prevent and mitigate abuse and gender-based violence
  • Necessary infection control measures must be in place and HIV treatment access needs to be maintained with no interruptions
  • Anticipatory stockpiling of contraception must be added to emergency preparedness plans
  • Development of novel vaccines and therapies must include pregnant and breastfeeding women
  • After the pandemic, the healthcare workforce must be adequately trained and staffed to address the increased demand for critical services, including obstetrics, family planning, therapy, and social work; healthcare providers must screen for COVID-19-related trauma, in addition to depression and anxiety

Conclusion

Unsurprisingly, the COVID-19 pandemic has amplified existing gender health disparities. Before the pandemic, healthcare, research, government, and funding institutions were already biased towards providing health services that predominantly benefited men. However, this global health crisis has highlighted how the lack of specific healthcare policies and practices for girls and women has resulted in over half the global population bearing the brunt of this historic and systemic neglect. To prepare for the aftermath of the pandemic, healthcare providers must take a gender-inclusive approach to deliver patient care (1) and all policymakers and stakeholders must include women and girls at the centre of their healthcare policies.

The unique healthcare conditions that girls and women live with have been brushed under the carpet for far too long, by far too many. It is our collective responsibility to talk about the healthcare challenges that women face and how these may be confounded by the preconceived roles of women in society and the biased expectations that women are required to live up to, especially in low- and middle-income countries. It is imperative to understand that not all women have the same experiences and this needs to be reflected in the way healthcare is delivered and how healthcare policies are conceived. The unique experiences of women of colour and gender-diverse individuals must also be openly discussed.

Clearly, there are many hurdles to identify and overcome regarding the gender health gap and ensure the health of women and girls across their biological life course is reflected in healthcare policies and the delivery of safe and effective clinical services. However, a brilliant starting point would be to begin conversations with women to understand their unique experiences and encourage discussions surrounding the specific healthcare challenges that women face, and potential solutions that are undeniably required. Our aim at Bham Pharma Ltd is to encourage women to speak up about their unique experiences and I hope that this blog serves as a conversation starter. The pandemic is far from over, but there is no time like the present to actively listen to the women in our lives, educate ourselves on the challenges that they face daily, and come up with practical solutions and policies to ensure that women are no longer neglected by our governments, research and funding institutions, and healthcare systems. 

References

  1. Connor J, Madhavan S, et al. Health risks and outcomes that disproportionately affect women during the COVID-19 pandemic: A review. Soc Sci Med. 2020;266:113364. doi: 10.1016/j.socscimed.2020.113364.
  2. World Economic Forum. (2021). The pandemic has hurt women’s health. This is why that’s bad for everyone. Available at: https://www.weforum.org/agenda/2021/09/lessons-must-be-learned-from-covid-19-s-impact-on-women-s-health-and-rights/. Last accessed: 07 December 2021.
  3. United Nations. Policy Brief: The Impact of COVID-19 on Women. 19 April 2020. Available at: https://www.unwomen.org/en/digital-library/publications/2020/04/policy-brief-the-impact-of-covid-19-on-women#view. Last accessed: 07 December 2021.
  4. Guerrina R, Borisch B, et al. Health and Gender Inequalities of the COVID-19 Pandemic: Adverse Impacts on Women’s Health, Wealth and Social Welfare. Front Glob Womens Health. 2021;2:670310. doi: 10.3389/fgwh.2021.670310.
  5. Akbas M, Sulu R, et al. Women’s health anxiety and psychological wellbeing during the COVID-19 pandemic. A descriptive study. Sao Paulo Med J. 2021;139(5):496–504.
  6. Thibaut F, van Wijngaarden-Cremers PJM. Women’s Mental Health in the Time of COVID-19 Pandemic. Front Glob Womens Health. 2020;1:588372. doi: 10.3389/fgwh.2020.588372.
  7. Burki T. The indirect impact of COVID-19 on women. Lancet Infect Dis. 2020;20(8):904–5. doi: 10.1016/S1473-3099(20)30568-5. 
  8. Almeida M, Shrestha AD, et al. The impact of the COVID-19 pandemic on women’s mental health. Arch Womens Ment Health. 2020;23(6):741–8. doi: 10.1007/s00737-020-01092-2.
  9. Cascini F, Pantovic A, et al. Attitudes, acceptance and hesitancy among the general population worldwide to receive the COVID-19 vaccines and their contributing factors: A systematic review. EClinicalMedicine. 2021;40:101113. doi: 10.1016/j.eclinm.2021.101113.
  10. Taylor M, Kobeissi L, et al. Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action. Lancet Glob Health. 2021;9(3):e366–e371. doi: 10.1016/S2214-109X(20)30484-8.
Get social with us!
LinkedIn
Share
Twitter
Visit Us
Follow Me
Instagram
Follow by Email
RSS
Medical Communications, Women's Health

Leave a Reply

Your email address will not be published.

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

This site uses Akismet to reduce spam. Learn how your comment data is processed.